Gastric Sleeve Surgery

updated
July 3, 2015

Gastric sleeve surgery is a new type bariatric surgery. This surgical approach involves the permanent removal of about 85 percent of the stomach so that it takes the shape of a tube rather than a large pouch. Although there is not as much long-term clinical evidence detailing the safety and efficacy of gastric sleeve surgery, surgeons have achieved promising results with this technique.

Candidates

Many surgeons believe that it is safer to perform gastric sleeve surgery prior to gastric bypass surgery, as part of a two-step weight loss program, in patients that have a BMI of 50 or higher. This allows patients to lose some of their excess weight before the more complicated gastric bypass procedure is performed.

Men and women that are considered morbidly obese (a BMI of 40 or higher) or obese (a BMI of 35 or higher) with an obesity-related health condition are also considered good candidates for surgery. In these cases, the procedure is typically performed on its own.

Additionally, candidates for gastric sleeve surgery should not smoke and be prepared to make several lifestyle changes before and after surgery. These lifestyle changes include:

Modification of diet

Regular exercise

Nutrition and fitness counseling

Psychological testing and counseling

The Procedure

To begin the procedure, patients are put under general anesthesia.

Next, several small incisions are made in the upper abdomen. A laparoscopic camera and small surgical tools are inserted through the incisions.

The camera guides the surgeon as he or she removes the fundus and the majority of the stomach and then closes the incision line with staples. The remaining stomach resembles the shape of a banana and is still connected to the esophagus and small intestine.

Recovery

Gastric sleeve surgery patients may stay in the hospital for one to two days after surgery, and then return home where they should rest for a couple of weeks before returning to work or other obligations. During this time, it is common to experience pain and swelling. Pain can managed with medication.

For the first two weeks after surgery, patients should maintain a liquid diet. The third and fourth week after surgery, patients can graduate to semi-solid foods. After that time, patients can begin eating solid food again. However, the stomach will only be able to hold about one cup at a time, so patients will need to consume several small meals each day rather than larger meals.

Some patients experience emotional trauma after surgery due to the many lifestyle changes to which they must become accustomed. Individual counseling and support groups can help get you through this difficult time.

Risks

Gastric sleeve surgery is associated with the following risk factors and concerns:

Swelling

Bruising

Pain

Bleeding

Infection

Allergic reaction to anesthesia or medications

Diarrhea

Constipation

Difficulty swallowing

Postoperative staple line leaks

Postoperative staple line bleeding

The procedure is irreversible

Lack of long-term research

Stenosis/Strictures

Increased risk of short-term gastroesophageal reflux disease (GERD)

Stroke

Heart attack

Death

Benefits

The gastric sleeve procedure offers many advantages, including:

Reduced risk of malabsorption or nutritional deficiencies

Improvement in obesity-related health conditions

May have a lower rate of risks and complications than gastric bypass procedures

Patients may experience fewer feelings of hunger than with gastric bypass

Does not require the placement of foreign material, as is required with gastric banding procedures.

Reduced risk of long-term GERD

Not associated with dumping syndrome

Does not require rerouting of digestive system

Costs

The cost of gastric sleeve surgery is comparable to other bariatric surgery procedures. The price typically ranges from $15,000 to $25,000, depending on the area in which the procedure is performed and the experience of the surgeon.